We welcome Tessa Richards' article about this fundamental issue.
However,
we suggest she does not go far enough.
Adoption of the practice of copying letters to patients has been
limited by
concerns about consent, confidentiality, cost and causing anxiety. Our
experience has been that these concerns are readily overcome if the letter
is
written to the patient rather than the GP. This has been our routine
practice
since 2005.
Hardly any patients refuse the offer of a letter and many are
grateful to hear
they will receive one. We do not believe that formal consent is necessary
as
this is not the case for other professions, such as lawyers and bank
managers, who write directly to clients.
We have sought feedback from patients and GPs through questionnaires
sent
out with the letters. Their comments illustrate the benefits: “I
appreciate the
letter addressed to me – the patient.” “I can now understand the
treatment I
am having for my illness and happy to know that I am making some progress
along the way.”
Many patients are unable to recall the verbal information they
receive during
a consultation. “I for one will have forgotten half of what you have told
me by
the time I get home.”
The letters provide useful continuity between clinicians. “Good to
keep the
letter, if you are under different consultants, you can just show them the
letter instead of explaining every time.” “… can update people at work
with
my progress when they ask.”
The patient is able to alert clinicians to typographical and factual
errors which
can then be corrected. “Wrong post code. 2 medications to be added to
list.”
“From 2/9/05 my GP has changed the Pravastatin to Simvastatin.”
The letter is a simple, timely way of passing on the results of tests
taken
during the consultation. “If my appointments are at 2 monthly intervals
my
knowledge of my current state is always 2 months old as I do not see
results
until my next appointment”..
Our practice has been welcomed by GP’s: “I asked all my partners
their views
on this ….. Excellent idea to send patients letters.” “Avoids
misunderstandings between what they [patients] think they were told and
what they were.”
A common concern is how to retain important clinical information if
the letter
is written in layman’s terms. Our letters contain a diagnosis or problem
list
using standard medical terminology. This provides concise information to
other doctors and allows patients to seek further advice from the internet
and
elsewhere about their diagnosis. The letter highlights important elements
of
the consultation including proposed investigations, changes in treatment
and
advice for action. Medical terms are accompanied by lay translations.
There
are no surprises – all the content of the letter should have been covered
during discussions in the clinic.
A current drugs list is always included, written in plain English
rather than
Latin abbreviations, for example “three times a day” instead of “t.d.s.”.
Changes to drug treatment are highlighted in bold.
Letters are always in English as the cost of professional translation
is
prohibitive. The letters are printed in large font if the patient is
visually
impaired.
Hospital doctors have traditionally learned to write clinic letters
by example.
Universal adoption of writing letters to patients will only occur if
training is
incorporated in undergraduate and postgraduate education programmes. We
devoted a departmental teaching session to translating examples of letters
to
GPs into letters to patients. The trainee doctors present often found
this
easier than the consultants.
Writing letters to patients has greatly increased both patient
satisfaction and
our professional satisfaction with our outpatient service. Why don’t you
give
it a try?
Competing interests:
None declared
Competing interests:
No competing interests
11 November 2008
Hugh C Rayner
Consultant in Renal Medicine and Medical Director - Medicine
Steve Smith
Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS
Rapid Response:
Write to the patient and send the copy to the GP
We welcome Tessa Richards' article about this fundamental issue.
However,
we suggest she does not go far enough.
Adoption of the practice of copying letters to patients has been
limited by
concerns about consent, confidentiality, cost and causing anxiety. Our
experience has been that these concerns are readily overcome if the letter
is
written to the patient rather than the GP. This has been our routine
practice
since 2005.
Hardly any patients refuse the offer of a letter and many are
grateful to hear
they will receive one. We do not believe that formal consent is necessary
as
this is not the case for other professions, such as lawyers and bank
managers, who write directly to clients.
We have sought feedback from patients and GPs through questionnaires
sent
out with the letters. Their comments illustrate the benefits: “I
appreciate the
letter addressed to me – the patient.” “I can now understand the
treatment I
am having for my illness and happy to know that I am making some progress
along the way.”
Many patients are unable to recall the verbal information they
receive during
a consultation. “I for one will have forgotten half of what you have told
me by
the time I get home.”
The letters provide useful continuity between clinicians. “Good to
keep the
letter, if you are under different consultants, you can just show them the
letter instead of explaining every time.” “… can update people at work
with
my progress when they ask.”
The patient is able to alert clinicians to typographical and factual
errors which
can then be corrected. “Wrong post code. 2 medications to be added to
list.”
“From 2/9/05 my GP has changed the Pravastatin to Simvastatin.”
The letter is a simple, timely way of passing on the results of tests
taken
during the consultation. “If my appointments are at 2 monthly intervals
my
knowledge of my current state is always 2 months old as I do not see
results
until my next appointment”..
Our practice has been welcomed by GP’s: “I asked all my partners
their views
on this ….. Excellent idea to send patients letters.” “Avoids
misunderstandings between what they [patients] think they were told and
what they were.”
A common concern is how to retain important clinical information if
the letter
is written in layman’s terms. Our letters contain a diagnosis or problem
list
using standard medical terminology. This provides concise information to
other doctors and allows patients to seek further advice from the internet
and
elsewhere about their diagnosis. The letter highlights important elements
of
the consultation including proposed investigations, changes in treatment
and
advice for action. Medical terms are accompanied by lay translations.
There
are no surprises – all the content of the letter should have been covered
during discussions in the clinic.
A current drugs list is always included, written in plain English
rather than
Latin abbreviations, for example “three times a day” instead of “t.d.s.”.
Changes to drug treatment are highlighted in bold.
Letters are always in English as the cost of professional translation
is
prohibitive. The letters are printed in large font if the patient is
visually
impaired.
Hospital doctors have traditionally learned to write clinic letters
by example.
Universal adoption of writing letters to patients will only occur if
training is
incorporated in undergraduate and postgraduate education programmes. We
devoted a departmental teaching session to translating examples of letters
to
GPs into letters to patients. The trainee doctors present often found
this
easier than the consultants.
Writing letters to patients has greatly increased both patient
satisfaction and
our professional satisfaction with our outpatient service. Why don’t you
give
it a try?
Competing interests:
None declared
Competing interests: No competing interests